Sunday, February 12, 2012

A Day in the Life - 1:45 pm

During Biology class, Leslie starts to feel like her blood sugar is getting low. In her words, “I feel low.” Unless you have diabetes, there is no way to understand what this means. Leslie describes it as a cross between being hungry and anxious – and that you need to do something about it quickly. It must be very unpleasant.

As defined in the 504 Plan, Leslie tells her teacher that she needs to see the school nurse and immediately she departs for the nurse’s office. Since she feels low, the plan requires that another student accompany her to see the nurse. Why does one of her classmates have to along? The other student is there to guide her to where she needs to be in case she becomes confused or disoriented from her low blood sugar.

The nurse, a very capable woman named Kelly, greets Leslie at the door and has her take a seat next to her desk. Leslie pulls out her meter, pricks her finger, and awaits the result: 136. This is her fourth glucose check of the day.

She isn’t low; but her blood sugar is dropping rapidly. She finished her lunch about an hour ago, consuming the 79 carbohydrate grams we packed plus a box of chocolate milk she obtained from a friend (12 grams) for a total of 91 grams. Since the insulin was given only about an hour ago, it is still active in her system – recall that insulin remains active for about 2 hours after injected. Her 136 mg/dL would be a great number if it were 2 hours after lunch, but since it has only been an hour, there is still insulin actively removing glucose from her blood. If she doesn’t eat now, then she will be dangerously low within the next 60 minutes.

The nurse gives Leslie a juice box and a package of snack crackers containing a total of 30 carbohydrate grams.

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